A nurse is preparing to perform a fundal massage for a postpartum client who is experiencing uterine atony. In which order should the nurse plan to perform the following actions?
Ask the client to lie on her back and with her knees flexed.
Position one hand around the top of the client's fundus and one hand just above the client's symphysis pubis.
Rotate the upper hand to massage the client's uterus while using slight downward pressure to compress the fundus.
Observe the client's perineum for the passage of clots and the amount of bleeding.
The Correct Answer is A, B, C, D
The correct answer is A, B, C, D.
The nurse should plan to perform the following actions in this order:
A. Ask the client to lie on her back and with her knees flexed.
B. Position one hand around the top of the client’s fundus and one hand just above the client’s symphysis pubis.
C. Rotate the upper hand to massage the client’s uterus while using slight downward pressure to compress the fundus.
D. Observe the client’s perineum for the passage of clots and the amount of
bleeding.
Fundal massage is performed to stimulate uterine contractions and prevent
postpartum hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that can result in dehydration, weight loss, and ketosis.
Clinicians suspect hyperemesis gravidarum based on symptoms and can support the diagnosis by measuring urine ketones.
Choice A, Rapid plasma reagin, is a blood test used to screen for syphilis.
Choice B, Prothrombin time, is a blood test that measures how long it takes for blood to clot.
Choice D, Urine culture, may be indicated because urinary tract infection is common in pregnancy and can be associated with nausea and vomiting.
However, urine ketones would be a more specific test for hyperemesis gravidarum.
Correct Answer is A
Explanation
A nurse should discontinue oxytocin if the client experiences uterine hyperkinesia, which is defined as more than 5 contractions in 10 minutes.
Choice B is not correct because contractions lasting 60 seconds are within the normal range.
Choice C is not correct because moderate variability of the fetal heart rate is a reassuring sign.
Choice D is not correct because nonrepetitive early decelerations are generally considered benign and do not require intervention.
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